The most important thing in life is knowing at the end of the day that you have made some sort of difference in the world. For this very reason, I obtained my degree in psychology several years ago and I was fortunate enough to receive employment at a rehabilitation institution for men, which specializes in individuals who have spinal cord injuries.

Naturally, those who are new to the world of physical disadvantage are particularly vulnerable to psychological ailments. Depression, for example, is rampant among my patients. Worse still, some people have a tendency to overcompensate for their feelings of inferiority from their disability. As Freud put it: "Such patients claim that have suffered enough, and have a claim to be spared any further exactions; they will submit no longer to disagreeable necessity.” I won’t allow my patients to believe they are now above the law due to their disabilities. I’d like to think that I equip them with the necessary tools for handling real life.

This morning I was assigned to speak with some of our younger patients. I must confess that the children are my favorites. You can truly make a difference with them, especially the youngest ones. Suicide and depression are rare entities in those younger than twelve and they tend to accept their lot cheerfully. Instead of moping about what they can’t do, they are eager to learn what they can do. I may never have children of my own, but I consider all my patients to be my sons.

There were about a dozen children in our group this morning, all with disabilities of varying degrees. Several of them were learning to walk with braces, although none would be free of the need for assistance for the remainder of their lives. I got them seated in a circle and they simply talked about their feelings and insecurities. Several were anxious about returning to school and I did my best to build their confidence.

Near the end of the session, I noticed that there was one boy, around age fourteen, who had not joined our group discussion. He had discovered one of the computers in the corner and was busily typing on it. From the fact that he was wheelchair-bound and utilizing a stick to type with, I surmised that the boy was a high quadriplegic. I scolded myself for allowing him to escape my attention.

I came over to him and waited patiently for him to acknowledge me. I try not to force my presence on these children. Finally, the boy turned and smiled shyly at me. “Hi,” he said, his teeth still clenched around the stick in his mouth.

“Hi,” I responded. “I’m Ned. What’s your name?”

The boy craned his neck to replace the stick in a small container attached to his wheelchair. “I’m James,” he said.

“Nice to meet you, James,” I said. “I’m very disappointed you didn’t participate in our discussion. I think it may have helped you.”

James shook his head. “All those kids are a lot younger than me.”

He was correct in that respect. Boys sixteen and older are not grouped with the children and James was just barely younger than this. It is an awkward age, I suppose. It is especially awkward if you are paralyzed from the neck down.

I had no intention of abandoning James, however. I made another attempt to engage him: “You seem to be doing quite well with your typing.”

“Yeah,” James said. “I’ve been working at it.”

I talked further with James about the progress he was making with his rehabilitation. He seemed to be proceeding excellently—I was quite impressed. But as we spoke, I sensed there was something on his mind that was worrying him. Something important.

Finally, I asked him outright: “James, I can see something is troubling you. Would you like to discuss it?”

James became teary-eyed at the question. He told me about how his girlfriend left him after his accident and all his friends acted strangely around him now. He was scared that he would never be able to have a relationship with a girl ever again. It is painful to hear a boy of fourteen speaking that way.

“You’re underestimating your fellow people,” I informed him. “Do you really think that you’re incapable of being loved now? Your parents and siblings still love you, don’t they? Believe me, there will be plenty of people who will appreciate you for your mind rather than your body.”

“I don’t want to be appreciated... I want a girlfriend,” James said.

“It’s too early to be thinking about girls,” I said. “First concentrate on rehab. Then you have the rest of your life to find a girlfriend.”

James still seemed dubious. “What about you?” he asked. “Do you find it hard to get girls?”

James was not the first to ask me this. Naturally, as I am in the vocation of helping men with spinal cord injuries, the subject of my own disability has been broached many times. In fact, I encourage these queries. I am, in fact, more severely disabled than the majority of my patients. And as a triple amputee, I am in a unique position to offer my own personal experience as a guide to my patients.

Of course, I don’t know what James was experiencing at this moment. I am limited by the fact that my limbs were amputated when I was very young, before I was capable of forming long-lasting memories. It was not due to an accident, rather it was from an infection that nearly cost me my life, but instead cost me most of both legs and my right arm just below the shoulder. I use an electric wheelchair and I have a prosthetic device with a hook on my right arm that helps me with many of the tasks of daily living.

James was staring at me, waiting for an answer. The answer to his question was not what he wanted to hear. I am now 29 years old and I have not yet been involved in any sort of long term relationship. However, I could not claim that this is due to a lack of interest from the opposite sex, rather that I am unwilling to settle for a person that I do not have a mental as well as physical connection with. I feel that the reason the rate of divorce is 50% is that people are too willing to jump into a relationship with a person that is not right for them. As I have not yet met a person I share such a connection with, I prefer to remain single. I am quite happy with my life.

And yes, the answer to the inevitable question is that I am still a virgin. But I am comfortable with my lack of sexual experience and I will admit it and discuss it freely with any patient who specifically asks me about it. There are many people who have lost their virginity but have never experienced love, and I feel that I am better off than these people.

Of course, I had to tell James the truth. “Yes, it is more difficult to build relationships,” I said. “But consider this: every worthwhile relationship requires effort, doesn’t it?”

When I completed my session with the children, the rehab center’s director Dr. Glenn Sherman was waiting to speak with me. “How’d it go, Neddie?” Glenn asked.

“The kids were wonderful,” I replied. I don’t like being called “Neddie” but I let it go.

“We’ve got a new patient for you,” Glenn said. “His name is Ronald Herran. He’s twenty years old.”

I couldn’t help but feel some misgivings. The late teens and early twenties are the worst age group to work with. They are by far the most cocky and headstrong, and the most resistant to my help. Still, I would never turn a patient away. “What else?”

“What can I say, Ned? He’s a mess.” Glenn shook his head. “He’s a heroin addict... or at least, he used to be before we cleaned him up. He went through a nice little withdrawal in the hospital. No insurance, of course. HIV negative by the grace of god. He doesn’t seem like that type at all either—he’s from some nice upper-middle class family and he looks like the kid next door. He got shot in the spine just below C5 while purchasing some drugs. Bullet went clear through the spinal cord. He’s not walking out of here. No chance.”

“How is he taking it?” I asked.

“How do you think?” Glenn lowered his voice, mimicking the patient: “‘Dr. Sherman, I’m going to walk out of here no matter what you say. You’ll see.’” Glenn sighed. “The kid’s got his elbow flexors, no extensors, and he can’t move his hands or wrists at all. But still he thinks he’s walking out of here. He’ll be able to feed himself and brush his teeth, but that’s about the best prognosis I can give him. He’s not even going to be able to do transfers himself.”

It didn’t surprise me to hear this. When people are given a diagnosis of permanent paralysis, they generally go through five stages, ending with acceptance. The first of these stages is denial. In people Ronald Herran’s age, this stage often lasts an extended amount of time. Yet it was important to get them to accept that they would never walk again, in order to begin teaching them how to live their lives.

“Where will he go after this?” I asked Glenn.

“That’s the problem,” Glenn said. “According to the kid, his parents aren’t going to be willing to take him home. He seemed pretty adamant about that. So if his parents can’t take him, there’s no way he could live on his own... we’ll have to set him up in some sort of nursing facility.”

Although I have seen it happen before and will undoubtedly see it again, I despise witnessing a young quadriplegic being sent to a nursing facility to spend the rest of his life. Ronald Herran was only twenty years old—far too young for such a fate. I wondered if there might be anything I could do to prevent this from occurring.

I found Ronald Herran in the gymnasium. The paraplegics were having a basketball game in the gym—I could hear the screeching of wheels out in the hallway. As I steered my own chair into the gym, I couldn’t help but feel a twinge of regret that my disability always kept me from participating in athletic activities.

Ronald Herran was sitting on the sidelines in a manual wheelchair that had obviously been brought in by one of the nurses. He was quite mesmerized by the game, his eyes pinned on the action so much so that he did not notice me approaching. It gave me an opportunity to study the boy surreptitiously.

I noticed that he was quite good looking in a boy next door sort of way, with light brown hair, a sprinkling of freckles across his nose, and surprisingly blue eyes. He was lanky and I could see the muscles in his bare arms had already significantly deteriorated. His deinnervated hands were curled up on his lap. He seemed completely oblivious to this fact, however, as he followed the game going on in front of him.

I pulled my wheelchair up close to him until he was forced to acknowledge me. He cocked his head to the side when he saw me, automatically making the assumption that I was another patient. The residents and even the other doctors tend to make that assumption and I try to correct them as hastily as possible. “Hey,” he said.

“Hey,” I responded, trying to engage him.

“I’m new here,” he said, flashing me a quick smile. “Name’s Ronnie.”

“Hi, Ronnie,” I said. “I’m Dr. Wilson.”

That got Ronald Herran’s attention. He stared at me for a minute, then grinned: “You’re kidding, right?”

“No.”

“You’re really a doc?”

“I’m a psychologist, yes,” I replied. “But you can call me Ned.”

“Nice to meet you, doc,” Ronnie said. “Uh... I mean, Ned.”

I couldn’t help but smile. From the looks of him, he seemed like a nice enough kid. It was hard for me to believe the details Glenn had given me about his life. How could this kid have been a heroin addict?

I noticed that Ronnie’s eyes seemed to stray toward the game. He appeared to be quite involved in it. “Did you play basketball?” I asked him.

“Still do,” Ronnie said. “Once I get out of here, first thing I’m gonna do is hit the courts. I really miss it.”

I recalled what Glenn had told me about Ronnie’s belief that he would walk again. I knew part of my job was to convince him otherwise. This is one part of my job that I don’t relish—breaking down their defense mechanisms so that they must accept their prognosis. Before acceptance is reached, nearly every patient goes through a stage of depression.

“Sorry, man,” Ronnie said, “I guess you’ve never been able to play...”

“Ronnie,” I began tentatively. “Would you be willing to come back with me to my office to talk in private?”

Ronnie’s eyes widened. “What are you saying, doc? You want to fuck me?”

I suppose I should have expected such a response from a boy who had been most likely selling his body to obtain drugs, but it still surprised me coming from Ronnie’s innocent face. One of the most important things I wanted to teach him was that the services at this center were free for him. Nobody expected anything in exchange for helping him. “No, Ronnie,” I said to him. “I just want to talk. About you.”

I obtained the aid of a nurse in bringing Ronnie to my office. I inquired about the reason that the boy had been placed in a manual wheelchair when he obviously could not control it. I discovered that it was Ronnie who refused the electric wheelchair. He had no interest in learning to use it.

“Nice office, Ned!” Ronnie exclaimed as the nurse pushed him inside. “Damn, you did well for yourself! You’re pretty young too. When did you become a shrink, anyway?”

“It was after I lost my arms and legs, if that’s what you’re asking,” I replied. “You’ll find there’s a lot you can do from a wheelchair if you put your mind to it.”

I studied Ronnie’s boyish face. He seemed even younger than twenty. There was this sort of cockeyed grin that was almost always on his face. His frame was thin and lanky, emphasized now that the muscles in his arms and legs were atrophied. How could this boy have been a drug addict? How could he have done any of the things Glenn had told me about?

I decided to reroute the conversation. “Are you having any heroin cravings?”

“My parents?” Ronnie laughed. “No way. I haven’t seen my parents in like four years. My dad kicked me out of the house when I was sixteen.”

“Why did he kick you out?”

Ronnie giggled. “Because I was a bad boy.”

“Would you be a little more specific, Ronnie?”

“Sure,” Ronnie said. He lifted his arm up in what seemed to be an attempt to scratch his nose. He had wrist drop thanks to his atrophied wrist extensors, but he was able to rub his nose with the back of his wrist. “My dad kicked me out because he found out I’m gay, which for him is probably the worst thing in the world.”

“How did he find out?”

“He caught me having sex with another guy on our living room sofa,” Ronnie said rather sheepishly. “I guess I could have been more careful. But he came home way earlier than he was supposed to.”

There was no doubt in my mind that Ronnie had subconsciously wanted to be caught in the act. “So he was upset by this?”

“You could say that,” Ronnie laughed. “I mean, he named me after Ronald Reagan, so that should give you an idea he’s not exactly Mister Liberal. He said he’d kill me if I didn’t get out, so I got the hell out.”

“Have you ever considered making amends with your father?”

“Yeah, right!” Ronnie smirked. “You don’t know my dad. He doesn’t forgive people easy. Or at all. Besides, I wouldn’t want to be the kind of person he wants me to be, if you know what I’m talking about.”

“So what are you going to do when you leave here, Ronnie?” I studied Ronnie’s boyish face carefully, waiting for his answer.

Ronnie lifted his paralyzed hands. “I’m not going to be like this forever. No offense, doc, but I’ve still got my arms and legs. And as long as they’re attached to my body, they’re going to move again. I know it.”

“Ronnie, listen to me carefully,” I said. I’ve given this speech many times, but it never grows any easier. Everyone takes it differently and I had an excellent idea of how Ronnie Herran would take it. “You are never going to walk again. You are never going to be able to move your hands or wrists again. You are going to be in a wheelchair for the rest of your life. You are going to need assistance with your daily activities for the rest of your life. Do you understand what I’m saying?”

I could look into Ronnie’s blue eyes and know that he was unable to conceive of the fact that my words were the truth. His denial was not so easily broken.

“I think you don’t know what you’re talking about, doc,” Ronnie said. He didn’t say it with any disrespect. Ronnie Herran was nothing if not respectful. “Who knows my body better than me? I’m walking out of this place, doc. Just remember I said it.”

Over the next several days, I had many more conversations with Ronnie Herran, but none of them were any more successful in convincing him that his disability was permanent. I had the opportunity to converse with Ronnie’s physical therapist Fran, who complained that Ronnie was her most difficult patient. The boy refused to learn how to use his electric wheelchair or how to write using a hand brace, but only insisted he wanted therapy to get him walking again and was livid that it was being withheld from him.

Fran was ready to throw up her hands in disgust, but I refused to give up quite so easily. When I come across challenging patients, I draw inspiration from my own life. Without my legs and missing an arm, I could easily have become a charity case if people had given up on me. But instead, here I am, acting as a guide for others. It would have been hypocritical of me to abandon Ronnie.

At the end of my first week treating Ronnie, I received an interesting visit in my office. At the door to my office was Ronnie Herran, sitting in a manual wheelchair with a big smile on his face and his paralyzed hands in his lap as usual, but he was being pushed by someone unfamiliar—an attractive gentleman in his forties.

“You must be Dr. Wilson,” the man said, in an ever-so-slightly accented voice.

“That’s right,” I said. Usually I tell people to call me Ned, but in this instance I held my tongue.

“My name is Julian LaRoche,” he said, beaming at me. “But you may call me Julian. I’m Ronnie’s... uncle.”

“I see,” I said. “It’s good to meet you. Would you care to have a seat?”

Naturally, I could not refuse this sort of request. Julian brought Ronnie out into the hallway and came back to my office. Once the door was closed, Julian became very serious. “What’s going to happen to him?” Julian inquired.

“Have you discussed his prognosis with his doctor?” I asked. I wanted to know if I was the one giving Uncle Julian the news.

“Yes,” Julian said. “The doctor said he will stay this way.”

“He can’t live on his own, obviously,” I said. “He’ll need 24-hour care. If his family is unwilling to take him in, we’ll have to set him up in some sort of nursing facility.”

“A nursing home?” A crease formed between Julian’s brows. “But he’s so young!”

“It’s necessary, unfortunately,” I told him. “Unless... a family member, such as perhaps... an uncle, is willing to take him in.”

Julian frowned. He appeared to be deep in thought. “I don’t know if that will be possible. I can’t care for Ronnie.”

“May I ask why not?”

“I just... can’t.”

“May I suggest the reason is that you’re not Ronnie’s uncle?”

Julian’s eyes narrowed in suspicion and then finally his lips curled into a smile. Naturally, I knew the instant I saw this man that he was no relative of Ronnie’s. I was uncertain of the exact nature of their relationship, but it was almost undoubtedly sexual.

“So what do you think I am?” Julian asked. “A dirty old man taking advantage of a young kid with no money?”

That was, in fact, precisely what I had been thinking. “It’s not my job to judge you,” I explained. “It’s my job to find a home for Ronnie.”

I am asked this question quite frequently in my line of work and I have no discomfort in giving an answer. “I had an infection when I was very young,” I told him. “They had to be amputated to save my life. I don’t remember it.”

“No doubt missing three limbs puts a crimp in your social life,” Julian observed. “If you were whole, I’m sure a good looking young man such as yourself would have no difficulty finding dates.”